working things out and, more or less, getting by

Crazy Expensive

Without going into too much boring detail, let’s just say that I’m in the middle of two completely separate health insurance problems, with completely separate insurance companies. On one hand, I’m trying to resolve a series of claims with my previous insurance company from last year with regard to which that company is exhibiting some of the most asshole-ish, unprofessional, and borderline illegal behavior I’ve seen in a long while. On the other hand, I’m trying to establish new coverage with a different company that is clearly operating in some sort of discriminatory loophole.

So, I gotta ask: How do you pay for your mental health care? If you are insured, do the technicalities of your insurance plan have an effect on your care? (Does it affect your visits, your provider choices, which medications you take?) If you are uninsured, how do you manage?

On top of all that, shall we start a discussion on mental health parity in general? It’s no secret that mental health care is really very expensive. It’s also no secret that more often than not mental illness impedes one’s ability to work. Further, it’s no secret that pharmaceutical companies are out there to ruthlessly gouge whomever will pay and that insurance companies really don’t feel like being gouged. Tack on the stigma that suggests that mental health disorders aren’t “real” illnesses…and we’re looking at some serious problems, in the middle of which I am currently sitting.

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Define Functioning is an open discussion forum for the self-defined "high-functioning" mentally ill, regardless of specific disorder or diagnosis. At the heart of this site is a belief that the "high-functioning" label is not only misleading, but dangerous. To be "high-functioning" is not to be better, fixed, or cured...it does not even mean that we've figured out how to fully live with and despite our specific challenges.

To further the conversations, any and all contributions are welcome. Please participate in the discussion topics already posted or offer new topics by emailing ∃ at definefunctioning[at]gmail[dot]com.

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That seriously SUX! Health insurance crap is just that. I pay out of pocket for both my therapist and psychiatrist because they don’t take insurance and they’re the best. How can we put a price on connection? I am lucky that I am on my wife’s insurance so my meds are covered. In September, one of my meds (Neurontin) was removed from the formulary. The generic doesn’t work for me so rather than bother with the insurance company, I went off it altogether. Not sure if that’s working but we’ll see. I feel like one of the lucky ones for sure.

The whole medical insurance parity makes me ill. There’s nothing I can say that hasn’t been said. The saddest thing I know is my wife’s daughter and husband (Republicans) don’t believe in health care for all and they struggle financially and didn’t have health care for years. and they have 2 daughters. America is weird.

Speaking of whether meds are or are not “formulary”…this is the “some sort of discriminatory loophole” I briefly mentioned above. They can’t necessarily deny me coverage because of my preexisting conditions, but they can make sure that the drugs I need because of my preexisting conditions aren’t covered on most of the plans offered. Ugh. Disgusting.

Right now, I am lucky in this regard, because I’m on SSDI, which means I have been getting Medicare for years. I am not poor enough to be eligible for Medicaid, because you have to be virtually starving to meet that requirement, but I am unable to work full-time, and have officially been so for a very long time. Therefore, I can’t make much money at my part time job, or I’ll lose my SSDI, which means that even though I am able to probably get a better paying job and make more money right now part time, I cannot do that because of the income limit with SSDI which is based on the amount of money you make and not the amount of hours you work, so say, if you could work the same amount of hours for double the money, but that money was more than $1,000 a month, then you couldn’t do that without losing SSDI. And then if you lose SSDI, you lose Medicare, eventually too, so you have to get yourself a full-time job that will hopefully provide you with health insurance, but as we all know in the real world, it will provide you with the same sucky situation that backward E described above.

So, since I’m trying to get a degree to be able to get a full-time job when I am able to work full-time in the future, and hopefully make enough money to support myself, I am more than a tad bit worried about not being able to afford my numerous medications, and my bi-weekly injections of Risperdal Consta once that time arrives. I certainly will not be making enough money, even if I ever finish my B.A., to get a high-paying job where expensive co-pays would not be a problem. That is not in the realm of reality for me. Having never really worked full time and being 36 years old, it’s not like I’m going to graduate with a B.A. in social sciences and be bringing in big bucks! So, what I have to look forward to is attempting to immediately find a job when I get out of school (or if I quit school without graduating first), and make sure that job has REALLY good health insurance that actually will cover all of my medications and not charge me huge co-pays and deductibles. If I believed that was really going to be possible, though, I’d be living in a fantasy world.

Parity around here meant “If your company’s insurance covers mental health treatment it must do it at the same rate as physical health treatment.” So many companies just dropped it all together. Thanks for that.

My therapist is willing to work out a cash rate, but it’s still pricey, and definitely effects how often I see her!